Lux study: Contribution of a three-dimensional, high dynamic range, ultra-high-definition heads-up visualization system to a significant delivered light intensity decrease during different types of ocular surgeries

Abstract

To explore the hypothesis that using a large, three-dimensional (3D), ultra-high-definition (4K), heads-up display (HUD) system in a real-life setting may be associated with a significant reduction in light intensity (LI) delivered during various types of eye surgery. Single center, post-learning curve observational study of 142 independent consecutive cases: 73 cataracts and 69 vitrectomies (VR). For each group, the only variable setting was the LI. The LI delivered by each source was calibrated in lumens (lm). In the VR group, the delivered LI dramatically decreased from the 80% reference to 27.8%±13.2% (P<0.0001) (4.3 to 1.5lm). Among these surgeries, 91.3% needed 40% or less LI (2.3lm). The corneal transparency and quality of pupil dilation showed some correlation with the results. In the cataract group, the difference was even more spectacular, from 80% to 15%±11.3% (P<0.0001) (2.5 to 0.3lm). Among these surgeries, 80.8% required less than 20% LI (0.5lm). The surgical time, LI variations and type of cataract seemed to influence the results, down to 9.6%±5.4% (P<0.0001) (0.22lm) for nuclear cataracts, which represented 63% of the cataract sample. The digital signal amplification with this HUD system allows comfortable posterior as well as anterior segment surgery despite the decrease in incident light, suggesting an unprecedented reduction in the risk of phototoxicity compared to conventional systems as well as a likely improvement in patient comfort.